Post-Acute Care in Elderly Trauma Patients: Use, Outcomes and Costs Project Summary/Abstract The broad research goals of this study are to understand what factors influence who and where elderly receive post-acute care after a major trauma, to determine what types of post- acute care settings lead to improved functional outcomes, and to identify patterns of post- acute care utilization and costs. The specific aims of this research study are: (1) to identify factors that influence initial post-acute care receipt and setting, specifically a) patient-level factors, b) health system-level and post-acute care geographic supply factors, (2) to determine the impact of post-acute care receipt and type of setting on short and long-term functional outcomes in elderly trauma patients, and on nursing home residence one year post-trauma;and (3) to identify common post-acute care utilization patterns, their effects on re-hospitalizations and costs to Medicare, as well as to patients and their caregivers. Reducing mortality and improving functional outcomes after trauma is one of the Healthy People 2010 objectives. This research addresses the elderly - a priority population of the Agency for Healthcare Research and Quality (AHRQ) and supports the agency's mission to improve the quality of health care and promote evidence-based decision-making. This study will fill in a gap in the literature on the comparative effectiveness of post-acute care to restore function and on the societal costs of post-acute care for elderly persons with trauma. This study will use advanced analytic methods so that fairer comparisons can be made between post-acute care settings due to differences in patient severity and other factors affecting patient's choice of the post-acute care setting. It seeks to provide evidence to support outcomes-based discharge planning decisions as well as to guide Medicare post-acute care payment policy decisions. This observational study draws on a unique and rich dataset that assesses elderly trauma patients'functional outcomes across all post-acute settings, including outpatient rehabilitation, not currently available elsewhere. By taking a societal perspective on costs, this study is also unique in quantifying the burden of uncompensated costs to patients and their caregivers within the broader context of changes to Medicare post-acute care payment policies. The results of this study will be timely to inform this debate, and add to the results of the Post Acute Care Payment Reform Demonstration, mandated under section 5008 of the Deficit Reduction Act (DRA) of 2006.